NHS Tayside has to “rapidly increase the pace” of progress in its organisation to avoid further financial meltdown in the wake of Covid-19, say auditors.
Giving evidence to the Scottish Parliament’s public audit and post-legislative scrutiny committee, Auditor General Stephen Boyle said the board has still to take into account the impact of the coronavirus in its financial plans.
The beleaguered health board is on its sixth year under a section 22 report, which are prepared by the Auditor General if any specific concerns or issues have been raised in the audit of one of the public bodies for which he is responsible.
Mr Boyle said it did appear NHS Tayside was to break even before the pandemic spread and that changes to its management and financial planning programmes was making progress in general, but slowly.
Coronavirus, he added, would have a serious impact on how the board would operate.
In the year 2019-20, the board had applied £26.3 million in savings, but still required an additional £7 million from the Scottish Government.
Pace of change must be quicker
The convener of the committee, Labour MSP Jenny Marra, questioned why progress was slow and what was costing the board so much it had been placed under a section 22 and special measures in previous years.
Mr Boyle said the board had identified a high cost of prescribing medication, general in-patient costs of people being in hospital and staffing models, caused by a high number of vacancies.
He said: “To break even in 2020-21, significant savings need to be made to achieve this.
“Covid has had a significant impact but the effects of this have not yet been reflected in (NHS Tayside’s) financial plans.
Really significant challenges remain”
Auditor General Stephen Boyle
“It now needs to do so.
“NHS Tayside also needs to implement its plans to improve mental health services.
“It is making progress under new executive leadership team but there are still risks ahead.
“A balanced financial position will depend on delivering its transformation programme.”
He added: “This progress has been long in the making. What we saw before the pandemic struck was an organisation that was making progress.
“Very significant savings by the board had to be made, but to do so in the context of the pandemic, it needs to rapidly increase the pace and deliver a new plan.
“Really significant challenges remain, although progress has been made.
“This is a board with significant challenges; all health boards have very significant challenges.”
Staff levels in mental health a concern
Ms Marra challenged the auditors on how many vacancies there are currently within NHS Tayside, which none could answer directly.
Mr Boyle did add the number was higher than the Scottish average.
Ms Marra added: “Residents in Tayside know what these vacancies are.
“That is the kind of information I was expecting from the report.
“I am really concerned about the staff levels in mental health.”
Ms Marra quoted the Strang inquiry into NHS Tayside’s “poor” mental health service, which criticised the board’s approach to mental health service provision, pointing out that at the last count only 7.85 full-time equivalent psychiatrists were employed by the board, when 26 were needed.
SNP MSP Colin Beattie added: “Every report over the last six years has said there has been an improvement but not one single item from the first report has been resolved.
“There is a central problem with governance, staff concerns about patient safety.
“It is not entirely encouraging.”
Financial improvement noted
Fiona Mitchell-Knight, audit director of Audit Services, added: “Over the last two years, there has been a sharper focus on savings (by the board).
“NHS Tayside does have historically high cost issues but we do see improvement.
“There are some positive points. Appointments in the board have been effective.
“There have been definite improvements in (NHS Tayside’s) financial planning and reporting of financial information.
“In the past, we could not rely on the board’s finance plans, we felt they were unrealistic.
“Over the last two years the board has delivered and overperformed its plans.”